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Posted by / 22-Mar-2019 02:51

Revalidating medicare enrollment

(11) "Personal information system" means a "system" that "maintains" "personal information" as those terms are defined in section 1347.01 of the Revised Code. (12) "Research" means a methodical investigation into a subject.

(13) "Routine" means commonplace, regular, habitual, or ordinary.

(14) "Routine information that is maintained for the purpose of internal office administration, the use of which would not adversely affect a person" as that phrase is used in division (F) of section 1347.01 of the Revised Code means personal information relating to employees and maintained by the agency for internal administrative and human resource purposes.

(15) "System or Information System" As defined in section 1347.01 of the Revised Code, "system" means any collection or group of related records that are kept in an organized manner and that are maintained by a state or local agency, and from which personal information is retrieved using the person's name or by an identifying number, symbol, or other identifier assigned to the person.

(2) The request for the service is originated by the consumer or the consumer's authorized representative.

(3) The service is rendered to an eligible medicaid consumer as defined in division 5101:1 of the Administrative Code.

(8) "Interconnection of Systems" Refers to a linking of systems that belong to more than one agency, or to an agency, and other organization , which linking of systems results in a system that permits each agency or organization involved in the linking to have unrestricted access to the systems of the other agencies and organizations. (10) "Personal information" has the same meaning as defined in division (E) of section 1347.01 of the Revised Code.(B) Procedures for accessing confidential personal information.(1) Criteria for accessing confidential personal information.Personal information systems of the Ohio department of medicaid (ODM) are managed on a "need-to-know" basis whereby the information owner determines the level of access required for an employee of the agency to fulfill his or her job duties.(E) The definition and conditions of medical necessity articulated in this rule apply throughout the entire medicaid program.More specific criteria regarding the conditions of medical necessity for particular categories of service may be set forth within ODM coverage policies or rules.

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Medical necessity is a fundamental concept underlying the medicaid program.(A) Medical necessity for individuals covered by early and periodic screening, diagnosis and treatment (EPSDT) is defined as procedures, items, or services that prevent, diagnose, evaluate, correct, ameliorate, or treat an adverse health condition such as an illness, injury, disease or its symptoms, emotional or behavioral dysfunction, intellectual deficit, cognitive impairment, or developmental disability.